People with advanced chronic kidney disease (CKD) have high morbidity and mortality especially during the period of transitioning to renal replacement therapy, namely dialysis. As CKD progresses, increasing frequency of nephrologist and other subspecialty visits may compete with primary care visits and impede care continuity. When multiple providers are present, there may be delays in complex management decisions. Even if there is a clearly designated primary provider, it may be unclear which provider should be mainly orchestrating care. Poor care continuity may lead to patient safety errors, unnecessary or harmful care, and care which is not aligned with patient preferences. Conversely, nephrology care (and other subspecialty care) may add value by providing disease-specific management for conditions where the primary care provider may feel less knowledgeable. We propose a retrospective cohort study to determine the relation between continuity of care and health outcomes among older adults with advanced CKD at the Veterans Affairs Health Care System, the largest integrated health care system in the United States. Using this large national cohort, our study will provide novel information concerning how subspecialist care can be optimally delivered to patients with a complex chronic disease. Our research will further understanding of how healthcare delivery in patients with advanced chronic kidney disease may affect health outcomes. In particular, we seek to understand how degree of continuity of care provided by various physicians may affect mortality and their progression of kidney disease. This has direct relevance to how physicians should optimally deliver care to any patient with advanced chronic kidney disease.